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American Journal of Clinical Nutrition, Vol. 71, No. 6, 1582-1588, June 2000
© 2000 American Society for Clinical Nutrition

Original Research Communications

Relation of serum retinol to acute phase proteins and malarial morbidity in Papua New Guinea children1,2,3

Francisco J Rosales, James D Topping, John E Smith, Anu H Shankar and A Catharine Ross

1 From the Nutrition and Veterinary Science Departments, The Pennsylvania State University, University Park; the Departments of International Health and Molecular Microbiology and Immunology, Johns Hopkins School of Hygiene and Public Health, Baltimore; and the Papua New Guinea Institute of Medical Research, Goroka.

Background: Acute phase proteins (APPs) are associated with malaria-induced hyporetinemia (serum retinol <0.70 µmol/L); however, the degree of the association is not well documented.

Objective: The association between malaria-induced hyporetinemia and APPs was assessed.

Design: In a cross-sectional study, 90 children with serum retinol concentrations from <0.35 to >1.05 µmol/L were selected from children in a clinical trial of vitamin A supplementation. Serum was collected before treatment allocation. Retinol binding protein (RBP) concentrations were determined by radioimmunoassays, and transthyretin, {alpha}1-acid glycoprotein (AGP), {alpha}1-antichymotrypsin, C-reactive protein (CRP), haptoglobin, and albumin concentrations by radial immunodiffusion assays.

Results: Children in the subsample had high rates of splenomegaly and Plasmodium-positive blood-smear slides (P < 0.01); AGP (Pearson's r = -0.40, P < 0.001) and CRP (r = -0.21, P = 0.04) were inversely correlated with retinol. The negative APPs RBP, transthyretin, and albumin were positively and significantly associated with retinol. All APPs, except {alpha}1-antichymotrypsin, were significantly correlated with splenomegaly. Of the positive APPs, AGP correlated with CRP (r = 0.37, P < 0.001), indicating chronic inflammation. In a stepwise regression analysis, 73% of retinol's variability was explained by RBP and transthyretin. The model predicted that a 1-SD increase in RBP or transthyretin increases retinol by {approx}0.38 or 0.47 µmol/L, respectively, whereas an equivalent increase in AGP decreases retinol by 0.12 µmol/L.

Conclusions: The RBP-transthyretin transport complex of retinol is not altered by inflammation. Positive APPs are useful markers of type and severity of inflammation; however, except for AGP, it is unlikely that they can correct for malaria-induced hyporetinemia.

Key Words: {alpha}1-Acid glycoprotein • albumin • {alpha}1-antichymotrypsin • C-reactive protein • haptoglobin • hyporetinemia • multiple linear regression • Plasmodium falciparum • retinol binding protein • serum retinol • transthyretin • children • Papua New Guinea




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